- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $8,763.29
| Facility | | $1,000.00 | $7,838.38 | $8,763.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.67 / $542.86 / $564.73
| Professional | | $532.67 | $542.86 | $564.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $528.90
| Professional | | $60.00 | $85.00 | $528.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,602.00 / $9,127.00 / $13,891.00
| Facility | | $6,602.00 | $9,127.00 | $13,891.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.80 / $918.50 / $1,319.29
| Professional | | $734.80 | $918.50 | $1,319.29 |